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Nursing Care Diagnosis for Coronary Artery Disease: A Comprehensive Guide

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Coronary artery disease (CAD) encompasses a spectrum of conditions affecting the arteries responsible for delivering vital nutrients, blood, and oxygen to the heart muscle. Atherosclerosis, the primary culprit behind CAD, is characterized by the accumulation of lipid deposits within the arterial walls. These plaque formations narrow the arteries, impeding blood flow and significantly elevating the risk of angina pectoris and myocardial infarction.

CAD is typically a progressive disease, often developing silently over many years. Individuals may remain asymptomatic until the condition becomes advanced, at which point symptoms like angina, shortness of breath (dyspnea), and persistent fatigue may manifest.

When blood flow through the coronary arteries is significantly compromised or completely blocked, it triggers ischemia and infarction within the heart muscle tissue. Insufficient blood and oxygen supply (ischemia) to the myocardium leads to decreased tissue perfusion and, ultimately, necrosis (infarction) if left unaddressed, necessitating prompt medical intervention.

In managing CAD, a crucial aspect involves modifying risk factors to both prevent the onset and slow the progression of the disease. Given the often-subtle nature of early CAD, identifying individuals at risk is paramount for proactive intervention and preventative care.

Nurses play a pivotal role in health promotion efforts aimed at managing modifiable risk factors associated with CAD. Educating patients about the disease process, its progression, and the importance of necessary lifestyle adjustments is fundamental in CAD prevention.

For patients presenting with symptomatic CAD, such as chest pain or dyspnea, pharmacological or surgical interventions become necessary. Medications like aspirin and cholesterol-lowering agents are commonly prescribed to mitigate blood clot formation, prevent heart attacks, and reduce plaque buildup within the arteries. Surgical procedures, including coronary angioplasty with stent placement, may be indicated to relieve blockages, widen the affected arteries, and restore optimal blood flow to the heart. Coronary artery bypass grafting (CABG) is typically considered for patients with multiple severely narrowed coronary arteries.

Nursing Assessment for Coronary Artery Disease

The nursing process begins with a comprehensive nursing assessment. This crucial initial step involves gathering thorough physical, psychosocial, emotional, and diagnostic data. Understanding both subjective and objective data related to CAD is essential for effective nursing care planning and intervention.

Review of Health History

1. Elicit General Symptoms: Begin by inquiring about the patient’s overall symptoms. Pay close attention to complaints such as:

  • Chest pain or discomfort
  • Shortness of breath (dyspnea), both at rest and during physical exertion
  • Rapid breathing (tachypnea)
  • Difficulty breathing while lying down or sitting (orthopnea)
  • Fainting or lightheadedness (syncope)
  • Heart palpitations
  • Swelling in the lower extremities (edema)
  • Pain in the legs, particularly during activity (claudication)
  • Difficulty performing everyday physical activities

2. Detailed Chest Pain Investigation: If the patient reports chest pain, delve deeper into its characteristics. Ask the patient to describe the pain, including:

  • Sensation of chest tightness, pressure, or squeezing
  • Heaviness or a crushing feeling
  • Burning sensation
  • Pain occurrence during physical activity
  • Pain triggers, such as emotional stress or substance use
  • Pain radiation to the jaw, neck, left arm, or back

3. Risk Factor Assessment: Thoroughly assess both non-modifiable and modifiable risk factors.

Non-modifiable risk factors:

  • Age: The natural aging process increases the likelihood of arterial damage and narrowing.
  • Gender: Men generally face a higher risk of CAD at younger ages. However, women’s risk significantly increases post-menopause.
  • Family history of early ischemic heart disease: A strong family history, particularly in first-degree male relatives diagnosed before age 55 or female relatives before age 65, significantly elevates risk.
  • Race/ethnicity: Certain minority groups, including Hispanics and African Americans, exhibit a higher prevalence of CAD.

Modifiable risk factors:

  • Hypertension: Uncontrolled high blood pressure can stiffen and damage arteries, accelerating CAD progression.
  • Hyperlipidemia/hypercholesterolemia: Elevated levels of low-density lipoprotein (LDL) cholesterol (“bad” cholesterol) and decreased high-density lipoprotein (HDL) cholesterol (“good” cholesterol) contribute to atherosclerosis.
  • Diabetes mellitus and Insulin Resistance: Diabetes and insulin resistance promote blood vessel hardening and fatty plaque accumulation.
  • Chronic Kidney Disease: Kidney disease disrupts blood pressure regulation, increasing cardiovascular risk.
  • Tobacco Use: Smoking, including both firsthand and secondhand exposure, causes blood vessel constriction and damage.
  • Obesity: Excess weight contributes to elevated cholesterol levels and plaque buildup in arteries.
  • Physical Inactivity: Lack of regular exercise elevates cholesterol levels and overall cardiovascular risk.
  • Unhealthy Diet: Diets high in saturated and trans fats contribute to elevated LDL cholesterol.
  • Chronic Stress: Prolonged stress increases inflammatory markers, promoting blood vessel narrowing.
  • Excessive Alcohol Consumption: Heavy alcohol use weakens the heart muscle and can contribute to blood clot formation.
  • Sleep Deprivation: Insufficient or poor-quality sleep elevates stress levels and can lead to blood vessel constriction.

4. Medication and Treatment History Review: Certain medications (e.g., anthracyclines, anabolic steroids) and prior vascular surgeries can compromise blood vessel integrity and should be noted.

Physical Assessment

1. Vital Signs Monitoring: Closely monitor vital signs. Reduced oxygenated blood supply to the heart can cause alterations, typically an increase, in pulse rate and blood pressure.

2. Electrocardiogram (EKG) and Telemetry: Obtain an EKG immediately upon reports of chest pain to assess for arrhythmias and ischemic changes. Continuous telemetry monitoring is indicated for patients with known cardiac history or those at high risk.

3. Systemic Physical Examination: Conduct a thorough system-by-system assessment:

  • Neck: Observe for jugular vein distention, indicating fluid overload or heart failure.
  • Central Nervous System (CNS): Assess for acute distress, dizziness, lightheadedness, syncope, and lethargy, which may suggest reduced cerebral perfusion.
  • Cardiovascular System: Assess for tachycardia, chest pain, abnormal heart sounds (murmurs, bruits), and irregular heartbeats (arrhythmias). Auscultate for murmurs at the apex and bruits in the carotid arteries.
  • Circulatory System: Evaluate peripheral pulses for strength and equality. Diminished pulses may indicate reduced peripheral perfusion.
  • Respiratory System: Assess for dyspnea, tachypnea, orthopnea, and abnormal breath sounds (crackles/rales), which may signify pulmonary congestion secondary to heart failure. Evaluate activity intolerance.
  • Gastrointestinal System: Note any nausea and vomiting, which can be associated with pain or reduced cardiac output.
  • Lymphatic System: Observe for peripheral edema, particularly in the lower extremities.
  • Musculoskeletal System: Inquire about pain in the neck, arm, back, jaw, or upper body, and assess for fatigue.
  • Integumentary System: Observe skin color for pallor or cyanosis and note excessive sweating (diaphoresis).

4. ASCVD Risk Score Calculation: Calculate the patient’s 10-year ASCVD (atherosclerotic cardiovascular disease) risk score. This tool estimates the risk of a cardiovascular event based on factors including:

  • Age
  • Gender
  • Race
  • Blood pressure
  • Cholesterol levels (total and HDL)
  • Current medications (e.g., statins)
  • Diabetes status
  • Smoking history

An ideal ASCVD risk score is considered low (<7.5%).

Diagnostic Procedures

1. Arrhythmia Detection: CAD-related ischemia can disrupt the heart’s electrical activity, leading to arrhythmias. Carefully monitor for arrhythmias on EKG, paying close attention to ST segment changes which may indicate cardiac ischemia. Other arrhythmias, such as atrial fibrillation, bundle branch blocks, and supraventricular tachycardia, may also be present.

2. Blood Work Analysis: Analyze results from the following blood tests:

  • Complete Blood Count (CBC) with differential: To assess for underlying infection (WBC count), blood clotting abnormalities (platelet count), and anemia (RBC levels).
  • B-type Natriuretic Peptide (BNP): Elevated BNP levels can indicate volume overload associated with cardiac causes. Note that BNP can be falsely elevated in kidney disease and lower in obese individuals.
  • Cardiac Enzymes (Troponin, CK-MB): Elevated troponin and CK-MB levels are highly indicative of acute myocardial ischemia or infarction.
  • Lipid Panel: To monitor for hypercholesterolemia, assessing total cholesterol, LDL, HDL, and triglycerides.
  • Ultra-sensitive C-reactive protein (us-CRP) or High-sensitivity CRP (hs-CRP): Elevated levels indicate vascular inflammation, a significant risk factor for CAD.
  • Liver Function Tests (LFTs): To evaluate liver function, particularly relevant given potential liver effects of cholesterol-lowering medications and in conditions like hemochromatosis, which can affect both liver and heart.

3. Stress Testing: Prepare and assist the patient with stress testing, a non-invasive method to evaluate the heart’s response to physical exertion and detect ischemia.

4. Cardiac Catheterization Preparation: Prepare the patient for cardiac catheterization (angiogram), the gold standard for visualizing coronary arteries and identifying blockages. Educate the patient about the invasive nature of the procedure and the use of contrast dye.

5. Further Investigations: Other diagnostic tests may include:

  • Echocardiogram: To visualize heart structure and valve function, useful for detecting valve abnormalities or underlying conditions like heart failure.
  • Exercise Treadmill Test: For patients with normal resting ECGs who can exercise, assessing for ischemia during exertion.
  • Nuclear Stress Test: Combines ECG with myocardial perfusion imaging to assess blood flow to the heart muscle at rest and during stress, particularly useful when ECG interpretation is challenging.
  • Stress Imaging (Dobutamine Stress Echo, etc.): For patients unable to exercise, pharmacological stress agents are used in conjunction with echocardiography or nuclear imaging.
  • Cardiac CT Scans: To detect calcium buildup in coronary arteries and identify potential blockages.
  • CT Coronary Angiogram: Similar to cardiac CT but uses contrast dye for more detailed visualization of coronary arteries.

Alt text: ECG reading showcasing ST-segment elevation, a key indicator of acute myocardial infarction related to coronary artery disease.

Nursing Interventions for Coronary Artery Disease

Effective nursing interventions are crucial for patient recovery and long-term management of CAD. These interventions aim to promote perfusion, manage symptoms, facilitate cardiac rehabilitation, and reduce future cardiovascular risk.

Promote Myocardial Perfusion

1. Reduce Cholesterol Plaque Buildup: Administer cholesterol-lowering medications as prescribed. Statins, fibrates, niacin, and bile acid sequestrants are commonly used to reduce LDL cholesterol and slow plaque formation.

2. Prevent Thrombus Formation: Administer antiplatelet medications, such as aspirin, to reduce blood clot risk. Low-dose aspirin is often recommended for primary prevention. Anticoagulants may be necessary for patients at higher risk of thromboembolic events.

3. Revascularization Procedures:

  • Coronary Angioplasty and Stent Placement (PCI): Prepare patients for percutaneous coronary intervention to open blocked arteries using a balloon catheter and stent. Provide pre- and post-procedure care.
  • Coronary Artery Bypass Grafting (CABG): For patients with multi-vessel disease, prepare them for CABG surgery to create new pathways for blood flow around blocked arteries. Provide comprehensive pre- and post-operative nursing care.

4. Cholesterol Level Monitoring: Regularly monitor cholesterol levels to assess medication effectiveness and guide ongoing management.

Symptom Management

1. Blood Pressure Control: Administer antihypertensive medications as prescribed. Beta-blockers, calcium channel blockers, ACE inhibitors, and ARBs are commonly used to manage hypertension in CAD patients.

2. Angina Relief: Administer nitroglycerin to dilate coronary arteries and relieve chest pain. Educate patients on proper nitroglycerin use and storage.

3. Angina Trigger Identification: Help patients identify and avoid angina triggers. Encourage them to keep a log of activities, stressors, and other factors that precipitate chest pain.

4. Ischemic Angina Management: Administer antianginal medications like ranolazine, often in combination with other cardiovascular medications (antihypertensives, nitrates, antiplatelets, lipid-lowering agents) to manage chronic and ischemic angina.

5. Blood Pressure Goal Maintenance: Emphasize the importance of maintaining blood pressure below 140/90 mmHg. Be aware that excessively low diastolic blood pressure (<60 mmHg) can worsen angina in some CAD patients.

Cardiac Rehabilitation

1. Cardiac Rehabilitation Program Adherence: Encourage patient participation and adherence to cardiac rehabilitation programs. These programs are tailored to individual needs and provide supervised exercise, education, and support for lifestyle modifications.

2. Complication Prevention: Highlight the role of cardiac rehabilitation in reducing the risk of complications and hospital readmissions post-CAD event or intervention.

3. Home and Community Health Services Referral: Facilitate referrals to home health or community-based cardiac rehabilitation services to ensure continuity of care after hospital discharge.

4. Motivation and Adherence Enhancement: Motivate patients to actively participate in and adhere to their cardiac rehabilitation plan, emphasizing the benefits in terms of improved outcomes, reduced mortality, and enhanced quality of life.

Risk Reduction and Prevention Measures

1. Promote Regular Physical Activity: Encourage patients to engage in at least 150 minutes of moderate-intensity aerobic exercise per week, incorporating strength training as well.

2. Achieve and Maintain Ideal Body Weight: Educate patients about the link between obesity and CAD, and support weight loss efforts through dietary counseling and exercise recommendations.

3. Patient Education: Provide comprehensive education on CAD, risk factors, medications, lifestyle modifications, and self-management strategies to improve adherence and promote patient-centered care.

4. Stress Management Techniques: Teach stress reduction techniques such as yoga, meditation, deep breathing exercises, and guided imagery to mitigate the impact of stress on cardiovascular health.

5. Comorbidity Management: Emphasize the importance of managing comorbidities like diabetes and hypertension to improve overall outcomes and prevent CAD progression.

6. Recognize and Respond to Symptoms: Educate patients about symptoms requiring immediate medical attention, such as chest pain unresponsive to nitroglycerin, and signs of heart attack or stroke.

7. Lifestyle Modification Education: Reinforce the importance of heart-healthy lifestyle changes: regular exercise, a balanced diet, smoking cessation, avoiding secondhand smoke, limiting alcohol intake, stress management, and addressing depression.

8. Omega-3 Fatty Acid Considerations: Discuss the potential benefits of omega-3 fatty acids (from fish, flaxseeds, soybeans, or supplements) in reducing inflammation and CAD risk.

9. Alternative Medicine Awareness: Advise patients to consult their healthcare provider before using herbal supplements, as some may interact with prescribed medications. Mention herbs like garlic, barley, oats, and psyllium that are sometimes used to support cholesterol and blood pressure management.

10. Cardiologist Follow-up: Emphasize the importance of regular follow-up appointments with a cardiologist for ongoing monitoring and treatment adjustments (typically every 3-6 months for diagnosed CAD).

Safety Considerations

1. Anticoagulant Therapy Precautions: When managing patients on anticoagulants, implement bleeding precautions.

2. Bleeding Precautions Implementation: Educate patients and implement measures to minimize bleeding risk: soft-bristled toothbrush, electric razors, avoiding forceful nose blowing, preventing constipation, and avoiding contact sports.

3. Medical Identification: Recommend that patients wear medical identification (bracelet, necklace, or tag) indicating their CAD diagnosis and anticoagulant use, alerting emergency responders to their condition and potential risks.

Nursing Care Plans for Coronary Artery Disease

Nursing care plans provide a structured framework for addressing identified nursing diagnoses and prioritizing assessments and interventions to achieve both short-term and long-term patient care goals. Common nursing diagnoses for CAD include:

Acute Pain

Chest pain (angina) is a hallmark symptom of CAD, resulting from myocardial ischemia due to reduced blood flow. Patients often describe it as pressure, tightness, or a heavy sensation in the chest.

Nursing Diagnosis: Acute Pain

Related Factors:

  • Increased cardiac workload
  • Decreased myocardial blood flow

Evidenced By:

  • Reports of chest pain (location, character, duration, intensity, and relieving/aggravating factors)
  • Diaphoresis
  • Distraction behaviors (restlessness, moaning)
  • Facial grimacing
  • Guarding or protective posture
  • Positioning to alleviate pain
  • Changes in vital signs (increased heart rate, blood pressure, respiratory rate)

Expected Outcomes:

  • Patient will report pain relief or satisfactory pain control (pain score within acceptable range).
  • Patient will demonstrate nonverbal pain relief behaviors (relaxed facial expression, absence of guarding).
  • Patient will verbalize understanding of angina triggers and appropriate actions to take during an episode, including when to seek emergency care.

Nursing Assessments:

1. Monitor Vital Signs: Assess and continuously monitor vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation). Pain can initially cause tachycardia and hypertension. However, with worsening cardiac output, hypotension and bradycardia may develop.

2. Pain Assessment: Conduct a thorough pain assessment using PQRST (Provoking factors, Quality, Region/Radiation, Severity, Timing). Differentiate anginal pain from other potential causes like heartburn or musculoskeletal pain. Unstable angina is characterized by increased intensity, unpredictability, longer duration, and lack of relief with rest or nitroglycerin compared to stable angina.

3. Diagnostic Study Review: Review ECG findings. ST-segment depression or T-wave inversion may be present during angina. ST-segment elevation or new Q waves indicate myocardial infarction.

Nursing Interventions:

1. Oxygen Administration: Administer supplemental oxygen as needed to maintain SpO2 ≥ 90%. However, avoid routine oxygen administration if SpO2 is within normal limits, as it may not be beneficial and could be harmful in certain situations.

2. Medication Administration: Administer prescribed medications promptly:

  • Nitroglycerin: To dilate coronary arteries and improve myocardial blood flow.
  • Morphine sulfate: For pain relief, to reduce anxiety, and to decrease myocardial oxygen demand.
  • Beta-blockers: To reduce heart rate and myocardial workload.

3. Positioning: Elevate the head of the bed to a semi-Fowler’s or high-Fowler’s position to promote comfort, reduce myocardial oxygen demand, and facilitate breathing.

4. Environmental Management: Create a calm and restful environment to reduce anxiety and minimize pain perception. Psychological and emotional stress can exacerbate angina.

5. Trigger Identification Education: Help the patient identify and understand angina triggers (e.g., exertion, stress, cold weather). Advise them to stop activity and rest if chest pain occurs.

Anxiety

Anxiety is a common emotional response to a cardiac event or diagnosis of CAD. Excessive anxiety can negatively impact patient well-being and cardiovascular health.

Nursing Diagnosis: Anxiety

Related Factors:

  • Situational crisis (acute cardiac event)
  • Perceived threat to health status
  • Pain
  • Underlying pathophysiological response
  • Fear of death or disability

Evidenced By:

  • Verbalization of anxious feelings, distress, and insecurity
  • Awareness of physiological symptoms (palpitations, shortness of breath)
  • Feelings of helplessness and apprehension
  • Restlessness and irritability
  • Insomnia
  • Increased heart rate, respiratory rate, and blood pressure
  • Diaphoresis
  • Trembling
  • Nausea

Expected Outcomes:

  • Patient will verbalize a reduction in anxiety levels.
  • Patient will demonstrate effective coping mechanisms and relaxation techniques.
  • Patient will report feeling more in control and less overwhelmed by their condition.

Nursing Assessments:

1. Stress Level Assessment: Assess the patient’s perceived stress level and coping mechanisms. Identify sources of anxiety (diagnosis, prognosis, treatment, lifestyle changes).

2. Vital Signs Monitoring: Monitor vital signs. Differentiate between anxiety-related physiological responses (tachycardia, hyperventilation) and those related to cardiac status.

Nursing Interventions:

1. Encourage Expression of Feelings: Provide a safe and supportive environment for the patient to express fears and anxieties. Active listening and empathy are crucial.

2. Reassurance and Calm Presence: Offer reassurance and maintain a calm and confident demeanor. Reiterate safety and the availability of effective treatments.

3. Medication Administration (Anxiolytics): Administer prescribed anxiolytic medications (e.g., benzodiazepines) judiciously to help manage severe anxiety, especially in the acute phase.

4. Provide Accurate Information: Offer clear, concise, and accurate information about CAD, treatment plan, and prognosis. Patient education reduces uncertainty and fear.

5. Relaxation Techniques Instruction: Teach and encourage relaxation techniques: deep breathing exercises, progressive muscle relaxation, guided imagery, meditation.

Alt text: A nurse is shown explaining coronary artery disease information to a patient, emphasizing patient education in nursing care.

Decreased Cardiac Output

CAD can compromise myocardial contractility and electrical conduction, leading to decreased cardiac output and inadequate tissue perfusion.

Nursing Diagnosis: Decreased Cardiac Output

Related Factors:

  • Altered contractility (myocardial ischemia, infarction)
  • Altered heart rate and rhythm (arrhythmias)
  • Structural changes (e.g., valve dysfunction)

Evidenced By:

  • Tachycardia or bradycardia
  • Arrhythmias on ECG
  • Angina
  • Fatigue and weakness
  • Activity intolerance
  • Dyspnea and orthopnea
  • Peripheral edema
  • Crackles in lungs
  • Decreased peripheral pulses
  • Cool, clammy skin
  • Restlessness and confusion
  • Decreased urine output

Expected Outcomes:

  • Patient will maintain adequate cardiac output as evidenced by stable vital signs, absence of chest pain and dyspnea, palpable peripheral pulses, and adequate urine output.
  • Patient will participate in activities that reduce cardiac workload.

Nursing Assessments:

1. Hemodynamic Monitoring: Continuously monitor heart rate, blood pressure, cardiac rhythm (ECG), and oxygen saturation. Assess for signs of decreased cardiac output.

2. Auscultation: Auscultate breath sounds for crackles (rales) indicating pulmonary congestion and heart sounds for murmurs, gallops (S3, S4), which may indicate heart failure or valve dysfunction.

3. Peripheral Circulation Assessment: Assess peripheral pulses for rate, rhythm, and quality. Evaluate skin color, temperature, and capillary refill. Assess for edema.

Nursing Interventions:

1. Rest and Activity Management: Promote adequate rest periods to reduce myocardial oxygen demand. Balance activity and rest, avoiding overexertion.

2. Valsalva Maneuver Avoidance: Instruct patients to avoid Valsalva maneuvers (straining during bowel movements) as they can stimulate the vagus nerve, causing bradycardia and reduced cardiac output.

3. Medication Administration (Inotropes, etc.): Administer medications as prescribed to improve cardiac output:

  • Inotropic agents (e.g., digoxin, dobutamine) to enhance myocardial contractility.
  • Diuretics to reduce fluid overload.
  • Vasodilators to reduce afterload.

4. Diagnostic and Therapeutic Procedure Preparation: Prepare the patient for diagnostic tests (echocardiogram, cardiac catheterization) and potential therapeutic procedures (PCI, CABG) to improve cardiac function.

Ineffective Peripheral Tissue Perfusion

CAD can lead to reduced blood flow to peripheral tissues due to arterial narrowing and obstruction.

Nursing Diagnosis: Ineffective Peripheral Tissue Perfusion

Related Factors:

  • Arterial obstruction (atherosclerosis, thrombus)
  • Reduced cardiac output
  • Hypovolemia
  • Vasoconstriction

Evidenced By:

  • Diminished or absent peripheral pulses
  • Cool, pale, or cyanotic extremities
  • Prolonged capillary refill (>3 seconds)
  • Pain in extremities (claudication, rest pain)
  • Numbness or tingling
  • Skin changes (thin, shiny, hairless skin; ulcerations; delayed wound healing)
  • Edema

Expected Outcomes:

  • Patient will demonstrate improved peripheral tissue perfusion as evidenced by palpable peripheral pulses, warm and dry extremities, normal skin color, and timely capillary refill.
  • Patient will report reduced pain and improved comfort in extremities.

Nursing Assessments:

1. Vascular Assessment: Assess peripheral pulses (pedal, posterior tibial, femoral, radial, brachial) bilaterally, noting rate, rhythm, and quality (strength).

2. Skin Assessment: Evaluate skin color, temperature, and condition of extremities. Assess for pallor, cyanosis, coolness, dryness, hair loss, and nail changes. Examine for edema and ulcerations.

3. Ankle-Brachial Index (ABI): Measure and calculate ABI as indicated to assess for peripheral artery disease.

4. Doppler Ultrasound: Use Doppler ultrasound to assess blood flow in peripheral arteries, especially if pulses are weak or non-palpable.

Nursing Interventions:

1. Vasodilator Administration: Administer vasodilators as prescribed to improve peripheral blood flow (e.g., nitroglycerin, hydralazine).

2. Surgical Procedure Preparation: Prepare patient for potential surgical interventions to improve peripheral perfusion (e.g., angioplasty, bypass surgery).

3. Antiplatelet Therapy: Administer aspirin or other antiplatelet agents as prescribed to reduce thrombus formation and improve blood flow.

4. Positioning and Mobility: Instruct the patient to avoid prolonged sitting or standing, crossing legs, and constrictive clothing. Encourage regular leg exercises (range of motion, ambulation as tolerated) and elevation of legs when sitting to promote venous return.

5. Cardiac Rehabilitation Referral: Refer to cardiac rehabilitation programs, which include exercise training and risk factor modification to improve peripheral circulation and overall cardiovascular health.

Risk for Unstable Blood Pressure

CAD and related cardiovascular dysfunction can predispose patients to unstable blood pressure, both hypertension and hypotension.

Nursing Diagnosis: Risk for Unstable Blood Pressure

Related Factors:

  • CAD pathophysiology (atherosclerosis, ischemia)
  • Impaired cardiac contractility
  • Arrhythmias
  • Medication effects
  • Fluid volume imbalances

Evidenced By:

A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred; the goal of interventions is prevention.

Expected Outcomes:

  • Patient will maintain blood pressure within prescribed parameters.
  • Patient will demonstrate tolerance to positional changes (sit to stand) without significant blood pressure fluctuations.
  • Patient will not experience complications related to unstable blood pressure (e.g., myocardial ischemia, stroke).

Nursing Assessments:

1. Blood Pressure Monitoring: Regularly monitor blood pressure in different positions (lying, sitting, standing) to assess for orthostatic hypotension or hypertension.

2. Symptom Assessment: Assess for symptoms of unstable blood pressure: dizziness, lightheadedness, syncope, chest pain, shortness of breath, fatigue.

3. Risk Factor Identification: Identify and address modifiable risk factors for blood pressure instability: medication non-adherence, dehydration, uncontrolled comorbidities (diabetes, kidney disease), stress, unhealthy lifestyle.

4. Body Weight Assessment: Assess for overweight or obesity, which can contribute to hypertension.

Nursing Interventions:

1. Activity Precautions: Advise caution with strenuous activities that can exacerbate blood pressure fluctuations.

2. Medication Administration (Antihypertensives, etc.): Administer antihypertensive medications as prescribed to manage hypertension. Monitor for side effects, including hypotension.

3. Blood Pressure Control Education: Educate patients about the importance of blood pressure control, medication adherence, lifestyle modifications, and self-monitoring of blood pressure at home.

4. Lifestyle Modification Counseling: Emphasize lifestyle changes to manage blood pressure: low-sodium diet, regular exercise, weight management, smoking cessation, stress reduction, and limiting alcohol intake.

5. Stress Testing Assistance: Assist with stress testing to evaluate blood pressure response to exertion and identify exertional hypotension or hypertension.

References

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